Trends in antifungal resistance in from a multicenter study conducted in Madrid (CANDIMAD study): fluconazole-resistant spreading has gained traction in 2022.

We previously conducted a multicenter surveillance study on epidemiology and antifungal resistance in Madrid (CANDIMAD study; 2019-2021), detecting an increase in fluconazole-resistant . We here present data on isolates collected in 2022. Furthermore, we report the epidemiology and antifungal resistance trends during the entire period, including an analysis per ward of admission. spp. incident isolates from blood cultures and intra-abdominal samples from patients cared for at 16 hospitals in Madrid, Spain, were tested with the EUCAST E.Def 7.3.2 method against amphotericin B, azoles, micafungin, anidulafungin, and ibrexafungerp and were molecularly characterized. In 2022, we collected 766 sp. isolates (686 patients; blood cultures, 48.8%). was the most common species found, and was undetected. No resistance to amphotericin B was found. Overall, resistance to echinocandins was low (0.7%), whereas fluconazole resistance was 12.0%, being higher in blood cultures (16.0%) mainly due to fluconazole-resistant clones harboring the Y132F-R398I ERG11p substitutions. Ibrexafungerp showed activity against the isolates tested. Whereas was the dominant species in most hospital wards, we observed increasing proportions in blood. During the entire period, echinocandin resistance rates remained steadily low, while fluconazole resistance increased in blood from 6.8% (2019) to 16% (2022), mainly due to fluconazole-resistant (2.6% in 2019 to 36.6% in 2022). Up to 7 out of 16 hospitals were affected by fluconazole-resistant . In conclusion, rampant clonal spreading of fluconazole-resistant genotypes is taking place in Madrid.